The overall aim of this study is to demonstrate the efficacy of an automated prompting device called Prompts for Handwashing Effectiveness, which will increase the duration of handwashing at Biloxi Specialty Hospital in Biloxi, Mississippi. Handwashing is the single most important procedure for preventing nosocomial infections and the CDC advocates that health providers wash for at least 15 seconds prior to and following patients contact. Our evidence indicates that providers wash their hands for only about 8 seconds, however. Our grant "Nosocomial Infection Control through Handwashing Prompts" demonstrated that voice reminders to wash hands increases handwashing frequency and decreases nosocomial infections in hospitals. The proposed work will alert providers when they have washed hands sufficiently or when they need to wash longer. We will use existing hardware and modified software to measure handwashing duration, deliver voice prompts and measure the change in handwashing duration at BSH, but not the change in infection rate, deferring that measurement to Phase II. In Phase III we will offer a commercial voice prompting system to hospitals, nursing homes and restaurants. There are about 2.4 million cases of nosocomial infection per year in US hospitals. They are estimated to directly cause 30,000 deaths and contribute to another 70,000 deaths each year. Nosocomial infections can cost over $30,000 per incident and account for $45 billion annually in extended care and treatment. Amron's automated voice prompting system achieved a 1/3 reduction in nosocomial infections in a previous study. If it were installed in every hospital in the US and achieved the reduction in nosocomial infection rate quoted above, then we should expect to reduce those infections, their costs and their associated deaths to about 68 % of their current value. That is, we should expect about 3/4 of a million less nosocomial infections in American hospitals at a reduction in cost of treatment of about $15 billion. Most importantly, Stop Staph might save about 32,000 lives per year. [unreadable] [unreadable]